Co-production in public health research grant writing: engaging underserved migrant mothers in the UK

Abstract Background In the UK, one in three births is to a non-UK born woman, but there is a gap in co-produced research to explore their experiences. The National Institute for Health and Care Research (NIHR) defines co-production as ‘an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility'. This project co-produced a grant proposal to improve maternity care for underserved migrant women in the UK. We reflect on transferrable learning for engaging those whose voices are less often heard in grant writing. Methods An expert by experience, an underserved migrant woman who gave birth in the UK, joined the research team. Four online engagement workshops were conducted; two involved only migrant women, two were multi-disciplinary. 26 underserved migrant women attended. NIHR INVOLVE public involvement guidance was consulted. Results Women said they were often asked about negative experiences which felt disempowering, and rarely asked about solutions. Thus, we shifted the focus of our work to co-designing solutions. Women said that having an expert by experience co-host workshops encouraged engagement, so we integrated this into our methods. Some women were uncomfortable in professional groups. Thus, our proposed steering and focus groups will have an expert by experience subgroup with elected members attending multi-disciplinary groups. We will engage mostly online as women preferred this to enable flexibility with childcare. The lead expert by experience helped form the proposal through brainstorming, co-drafting, and feedback; experts by experience commented on the draft via email and workshops. The lead expert by experience wished to gain further experience of research methods, for which we requested additional funding. Conclusions This project highlights the immense potential for co-production in public health research, and the value of adapting research planning to maximise the voices of the less often heard. Key messages • Engaging experts by experiences in public health research planning is key to ensuring our work addresses the needs of underserved communities. • Co-Production of research requires determination to involve those whose voices are less often heard from the beginning of the research process, and to commit to joined working throughout.


Background:
National identities are socially constructed and imaginary groups with real-life consequences. Migrants are in a heightened risk to be treated as 'others' who do not belong to society. It remains unclear, to what extent national belonging is experienced among Finnish migrants and what consequences on health this has. We study migrants' sense of belonging to Finns, how it's manifested in sociodemographic groups and whether it's associated with psychological strain.

Methods:
We used nationally representative data from the crosssectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6836). National belonging was assessed by the item ''Finns'' in question ''which of the following areas or groups you feel you belong to?''. Response options fully and quite a lot were coded to indicate sense of belonging. Logistic regression was used to test the association between belonging, sociodemographic factors and psychological strain . Weights were used to correct the sample. Results: 51% reported sense of belonging to Finns. 46% of those aged 30-44 reported sense of belonging to Finns, whereas the youngest and oldest age groups yielded highest prevalences (18-29 = 53% and 45-64 = 58%, p<.001). Married persons reported sense of belonging to Finns more than those who weren't (55% vs. 48%, p<.01). Country group accounted for the variation in Finnish identification with a p-value of less than 0.001. Only 27 percent of those born in East Asia reported sense of belonging to Finns, whereas almost 60% of those born in Middle East and North Africa sensed belonging to Finns. Those with sense of belonging to Finns were twice as likely to report lack of psychological strain than those with no sense of belonging to Finns (p<.001).

Conclusions:
Achieving national belonging to the receiving society seems to be more difficult or non-appealing for some migrant populations than others. Lack of national belonging poses risk of deterioration of mental health.

Key messages:
The socially constructed boundaries of national belonging can be exclusionary and have negative consequences for the health of migrant populations. Experiencing a sense of national belonging to the country of residence has positive associations with mental wellbeing.

Background:
Descriptions of homeless individuals' somatic and psychiatric health status remain scarce. The heterogenicity of the population is increasing, with more people migrating within the European Union. Migration history has been described as a determinant of health and healthcare access.

Methods:
A multicenter cross-sectional study design included homeless individuals in Germany. Using interview-based questionnaires, the prevalence of mental and somatic illnesses, as well as healthcare use and access, were determined. Multinominal logistic regression analysis was performed to examine the influence of the homeless migration history on health status. Results: 306/635 (48.2%) of the homeless individuals were born outside Germany; 213/306 (69.6%) came from another EU country. Homeless people from EU countries frequently reported economic reasons for leaving their home country (51.0%) and entering Germany (64.4%). Compared to homeless individuals of German origin and homeless non-EU migrants, they stated to live rough (48.2% p = 0,03), not hold health insurance (62.4% p < 0,0001), and not receive state funds (82.6% p < 0,0001) more often. Prevalences of psychiatric and somatic illnesses among homeless people were high compared to the general German population. There were no differences observed between the prevalence of chronic diseases if stratified by the origin of the homeless individuals.

Conclusions:
Homeless individuals report higher prevalences of psychiatric and somatic illnesses than the general population. Compared to homeless people of other origins, homeless EU migrants may be disadvantaged in their housing situation and integration into the German social security system. Key messages: Programs aiming to integrate homeless people into mainstream health care should focus on homeless EU migrants. Our data underline the need for specific care services for homeless individuals.

Background:
In the UK, one in three births is to a non-UK born woman, but there is a gap in co-produced research to explore their experiences. The National Institute for Health and Care Research (NIHR) defines co-production as 'an approach in which researchers, practitioners, and members of the public work together, sharing power and responsibility'. This project co-produced a grant proposal to improve maternity care for underserved migrant women in the UK. We reflect on transferrable learning for engaging those whose voices are less often heard in grant writing.

Methods:
An expert by experience, an underserved migrant woman who gave birth in the UK, joined the research team. Four online engagement workshops were conducted; two involved only migrant women, two were multi-disciplinary. 26 underserved migrant women attended. NIHR INVOLVE public involvement guidance was consulted.

Results:
Women said they were often asked about negative experiences which felt disempowering, and rarely asked about solutions. Thus, we shifted the focus of our work to co-designing solutions. Women said that having an expert by experience cohost workshops encouraged engagement, so we integrated this into our methods. Some women were uncomfortable in professional groups. Thus, our proposed steering and focus groups will have an expert by experience subgroup with elected members attending multi-disciplinary groups. We will engage mostly online as women preferred this to enable flexibility with childcare. The lead expert by experience helped form the proposal through brainstorming, co-drafting, and feedback; experts by experience commented on the draft via email and workshops. The lead expert by experience wished to gain further experience of research methods, for which we requested additional funding.

Conclusions:
This project highlights the immense potential for co-production in public health research, and the value of adapting research planning to maximise the voices of the less often heard.

Key messages:
Engaging experts by experiences in public health research planning is key to ensuring our work addresses the needs of underserved communities. Co-Production of research requires determination to involve those whose voices are less often heard from the beginning of the research process, and to commit to joined working throughout. Among almost millions of children asylum seekers registered in the EU in 2015-2017, there were one-fifth unaccompanied children. These children are facing many challenges, including substance use while at the same time the recommendations for prevention are underdeveloped in many countries. To address the issue of substance use among migrant children in Serbia, the Institute of Public Health of Serbia with the support of the UNICEF and in cooperation with other partners developed recommendations for preventive activities in 2022 based on the migrant needs and country-specific situation. In the first phase of development, a desk review of current legislation and available relevant data was done. In the second phase, in order to gain in-depth view of the challenges and opportunities, workshops were conducted in two migrant centers with medical and other staff. Based on the findings and consultation process, feasible, evidence-based interventions were recommended. Several barriers to the implementation of evidencebased prevention activities in migrant centers were identified.
To address the knowledge gap on the management of acute intoxication and the current referral system, guidelines were developed. The diversity of professional backgrounds of staff in migrant centers was identified as a barrier and recommendations for further training were made. There are several barriers that need further action and solutions such as short periods of stay in centers that hinder the provision of structured programs, language barriers, and ethical issues for minors, especially unaccompanied children. Prevention activities in migrant centers need to consider the specific needs of migrants, such as language barrier, capacities, and relevant knowledge of available staff and country-specific situations. The development of guidelines and a flowchart for a referral system for migrants at risk for substance abuse and dependence can be a useful tool for staff in migrant centers.

Background:
The COVID-19 syndemic reveals social and health inequalities, putting marginalized groups such as migrants at greater risk. Yet health systems fail to routinely monitor the health of migrants, refugees, and internally displaced persons. Our systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 infection risk, transmission, outcome of disease and risk of severe course of disease among migrant populations. It further aims to compile extant evidence on COVID-19 vaccination coverage among these groups, and on the effects of pandemic control measures on their health. Methods: Following PRISMA guidelines, we registered a review protocol, searched 14 scientific databases and 4 pre-print servers using the WHO database of global literature on COVID-19, and hand-searched relevant websites for grey literature. The search period covers the time from 12/2019 to 11/30/2021. Articles in English, German and Spanish and all study designs were included.

Results:
A total of 6966 references were identified for title and abstract screening. 518 records were screened in full-text, out of which 204 articles were included so far (conflict solving at full-text stage and data extraction are ongoing). Our review presents a broad landscape of different study designs, migrant populations and COVID-19 outcomes. Based on previous work, we 15th European Public Health Conference 2022